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July 25, 2012

MSM Able to Use Home HIV Tests to Screen Sex Partners and Lower Risk

by Trenton Straube

Men who have sex with men and are at “high, high risk” of HIV can successfully use in-home rapid HIV tests to screen their sexual partners for the virus, according to a study involving a sample of this MSM population. The research, by Alex Carballo-Dieguez, PhD, and his colleagues at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, was presented Tuesday, July 24, during an oral poster discussion at the XIX International AIDS Conference (AIDS 2012) in Washington, DC.

Participants in the study found the oral swab tests easy to use and “highly acceptable,” according to the researchers. The in-home tests helped these MSM identify high-risk partners—in fact, 10 men tested positive—and the tests helped the participants modify their own behavior so they were at lower risk of contracting HIV.

The topic of in-home HIV testing is no longer a hypothetical one. In July, the Food and Drug Administration approved the first such test, the OraQuick In-Home Rapid HIV test, which, according to the manufacturer OraSure, is expected to be available over the counter this October at “slightly more” than $17.50.

But would men who engage in high-risk sexual behavior—specifically, non-monogamous men who don’t use condoms when they have receptive anal sex with other men—be interested in testing their partners before hooking up? What would their motivations be? What problems—such as physical violence—could arise? In short, could the home tests be a successful harm-reduction technique?

To explore these topics, Carballo-Dieguez and his colleagues recruited 32 men in New York City to partake in a study. Each participant received 16 test kits to take home and use as an option. Carballo-Dieguez sought out men he characterized as “high, high risk”—they had multiple partners and reported never using condoms the last 10 times they had sex, or they had more than four partners in the past year and used condoms less than 80 percent of the time.

The average age of participants was 34. Forty-one percent were white, 33 percent were African American, and 19 percent were Latino. In the previous three months, participants had an average of 15 male sexual partners, 11 occasions of unprotected receptive anal intercourse and nine occasions of unprotected insertive anal intercourse. In addition, 48 percent had a lifetime history of sexually transmitted infections (STIs), 93 percent used alcohol in the previous three months, and 56 percent used marijuana during that same time period.

Before enrolling, participants performed a self-test using the home test in the researchers’ offices. During the three-month study period, they filed, via a phone system, weekly reports on their sexual behavior. And for the duration of the study, researchers set up a 24-hour hotline run by clinical psychologists.

Of the 32 men enrolled, 27 used the home tests to screen their partners. Of the nearly 140 sexual partners they encountered during the study period, 101 (72 percent) men agreed to take the home test, 23 (16 percent) men refused and 17 (12 percent) were not asked. The tests were used at home and, occasionally, in public.

Ten men tested positive for HIV; six of them did not know they were living with the virus. In addition, two partners disclosed that they were HIV positive once they were asked to take a home test. When a partner did test positive, the men did not have sexual intercourse. However, the researchers note, the participants did show empathy for their partners who tested positive.

There were four calls to the hotline, but Carballo-Dieguez said that all four calls were about clarifying the test results—for example, interpreting whether two lines meant a positive or negative reading.

He also noted that of the 124 partners asked to use the home test, there were seven instances of verbally aggressive reactions, but that no one resorted to physical violence.

In general, the researchers noted several other results: Participants liked having access to the home testing kits and found them easy to use, and they carried the kits around to various locations. Most partners were willing to take the test, and if they weren’t, the refusal was viewed as a warning sign. Often, mutual testing took place, and the period they waited for results gave them time to re-evaluate whether they really wanted to have unsafe sex. In most instances, substance abuse didn’t interfere with the home testing process. The tests had a high acceptability among ethnic minorities. And finally, participants said the experiences with home testing shifted their own awareness of HIV risk, which in turn led them to take fewer risks.

During the discussion period, audience members brought up concerns about using home testing to weed out HIV-positive sexual partners and thus lower risk. As one German conference delegate put it: “I remember a time when condom use was posed as a method to have sex with MSM without needing to know who was infected. Is that time over?”

“I think the [MSM] community is further ahead than we are as prevention workers,” Carballo-Dieguez replied. “Unfortunately we have a patronizing approach to people; we think we have to treat them like they’re fainting violets. These men are not! We have to catch up to where things are, and we have to empower people if we can.”

On the challenges of stigma and the window period—the highly infectious time shortly after a person contracts HIV but when the antibodies won’t show up on a home test—Carballo-Dieguez acknowledged that the home test isn’t 100 percent perfect. “When I talk about testing, I understand there is a risk for some people,” he said. “But it’s also an opportunity to empower people to put prevention in their own hands, and this is something people can do on their own. It’s technology that’s already available. It is something that can have an effect for some people—for certain people. If tools are there, we have to find a way to clarify [them]. For example, we can say, ‘This is how some people use [the test]. You make your choice.’ It is up to them.

“We are still giving people an efficient tool to screen [HIV risk],” he said. “Sometimes, because we want something that is optimal we don’t work with something that is good enough.”

In the written abstract of the study, the researchers conclude: “MSM at high risk can use [home tests] to screen sexual partners, and many partners will agree to take the test. Use of HT results in detection of previously unknown infections and avoidance of HIV exposure. Making [home tests] available within networks where high-risk sexual practices are common may be a cost-effective way to identify previously undetected cases. [Home tests] may become an important harm reduction technology.”

(Note: The POZ team reviews all comments before they are posted. Please do not include either ":" or "@" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)

Jeton Ademaj, Harlem, NYC, 2012-09-18 14:06:42
Mitch u go where most can never follow, then u whine that u stand alone. the testing kit does NOT include chloroform or a hammer, taking the test is VOLUNTARY. poz ppl will never have the power to declare what method neg ppl may use to avoid PERCEIVED sexual risk...ACTING UP works for access to meds n funding, but it FAILS BITTERLY in persuading neg ppl to accept arguments such as urs. wanna screech about EVERY new prevention tool that's NOT condoms? fine...but the world has moved past ur noise.

Mitch, , 2012-09-14 22:18:43
Frederick, you ask what is " the problem". I can name half a dozen problems. The biggest is my concern for those who learn their status from this type of situation. The whole scenario literally presumes that the well being of newly DX'd are less important than the sexual options of the negative. It's a total slap in the face to everyone of us, but this hits some of our most vulnerable hardest. Ending AIDS should not come through ending the lives, dignity or equality of those with AIDS.

Mitch, , 2012-09-14 22:09:41
You're missing the point as always Jeton. I'm not "selling nondisclosure". I'm advocating equal treatment. "Disclosure" is PC for segregation. It isolates HIV as a special virus, more a social label than a disease. Its become leprosy! No one in their right mind would expect a casual partner to tell them if they had any other STD, even if it was fatal. The fact that you see this as "selling nondisclosure" rather than treating people with HIV like humans shows that you're blind to this.

Frederick Wright, Coachelly, 2012-09-13 11:23:05
Mitch,
I am not sure where all the deep fear is coming from and is it all about being a victim and not getting your orgainizism. The debate is over concerning IN HOME SCREENING KITS, freely and openly marketed in the USA. Now the debate is focused on the community and how we treat one another or will Men grow up and be Men of HONOR and Intergty to learn how to love one another.Mitch what is realy the problem,look deep inside and know you are worth being loved,lets END AIDS together.Canweagree

Jeton Ademaj, Harlem, NYC, 2012-09-12 12:02:58
Mitch, 5 weeks for a weak attack? u rebutted exactly nothing i wrote, nor have u thwarted the growing market for private testing. guess what? the complete contempt so many gay men show for each other reaches a breaking point where HIV-disclosure is concerned, full stop. spare me ur whining, instead go try n sell non-disclosure to the world. "but ur just a trick, why should i tell u anything?". guys like u r only capable of bestowing a credibility deficit on all poz ppl...n thus, home testing!

Mitch, , 2012-09-10 01:58:53
Jeton, you intentionally conflate the issues of disclosure and prevention. I'm sure even [you don't] believe they're one and the same. Disclosure is BS, and the height of seronegative selfishness. It literally presumes that the purpose of a test is not for personal health, but for quarantine, and acts on the economically ludicrous notion that strangers act out of concern for other strangers. It doesn't allay paranoia any more than the mandatory tattoos you probably also enrose

Nvhorseman, Reno, NV., 2012-08-22 21:36:32
My concern, should someone take this test and the results are an accurate "positive" or a "false positive" there are many issues that need addressing. After the possible "high" of the night that may or may not have led to unsafe sex, the results of the test could send someone over the edge when they sober in the morning. Were testing to be done at a clinic psych services or prophylaxis like PREP could be offered. What about tests for incurable "clap", HPV (anal cancer) HVB/C-They can kill too.

Alex Supertramp, , 2012-08-22 19:44:03
... and what about the suicides?

Frederick Wright, Coachella Valley, 2012-08-20 08:14:52
I think their is a lot of good points in the conversation below for here in the valley ASO's are still puffed up with wanting to stop this progressive HIV screening Kits. My hopes are that these ASO start educating the community and start publicly branding this as a HIV SCREENING KIT and is time to start educating the community on the HIV Rapit Screening KITS and stop the whinning already. ASO, community leaders start educating the community on this Screening KIT, by first educating your staff.

Scott Davis, Eugene, 2012-08-15 12:08:31
I am afraid too many people will not know enough about the window period and assume that a absent result is negative. I use the oral test in testing and it can pick up results earlier then the Western Blot test I am think it will give many folks a false sense of security. It's still best to use a condom. I still wonder what it would be like to be in a situation where your getting ready to have sex with someone and you get a reactive result. Not everyone is prepared for that.

RZ, Washington, DC, 2012-08-07 10:32:43
I believe each of us is responsible for our health AND each of us is responsible for doing as little harm as possible in life.All this gets severly tested in the heat of passion. Ideally, each person would have a number of their arm accurately indicating the probability of their passing the virus. Don't hold your breath waiting for that. The safest bet is to assume we're all positive and always use condoms. Anything that helps people know the risk they are taking will save some lives.

Martin, Cologne, 2012-08-02 08:28:56
I am on ART since 2007 and my viral load has been below the detection limit since. Still I would test positive in a (home) hiv test.
Someone who was infected, say, 6 weeks ago might have a VL in the millions, but still test negative.
Guess who is more infectious?
Guess who'll be allowed to stay for a f*ck?
This bedside-test will not slow down, but accelerate HIV spreading; particularly in a group with high sexual activity. Sad to see that money is spent on such obvious rubbish!

Jeton Ademaj, Harlem, NYC, 2012-08-02 01:37:36
Mitch, the self-interest of non-disclosure feeds the paranoia that led to criminalization laws and HIV-stigma in the first place. Bigotry indeed, BUT ALSO the accumulated political fall-out of people hiding their status when the disease WAS a guaranteed sentence of hideous death! the condom-brainwashing paradigm FAILED...home-testing, PrEP, serosorting/positioning emerged. more changes coming. IF u want "tricks" to understand undetectability, respect them n their right to know. bitching is FAIL.

Mitch, , 2012-08-01 13:13:57
The problem is that when we're taking it as "their right to bareback" vs a newly diagnosed right dignity, counseling and healthcare, we come out in favor of their barebacking. If that doesn't infuriate you, you're blinded by your fetish. Further, the epidemiological reality of who is spreading HIV seems to be ignored in favor of an imperative that brainlessly favors serosegregation. Those of us who are treated aren't more infectious than the average, so what virtue is in disclosing to tricks?

Frederick Wright, Coachellla Valley, 2012-08-01 00:07:04
This is a personal decession and their is no one group to blame for it is technology moving forward and the begining of Stima being broken down. One person at a time. The other choice is tricks will have options to focus on one partner or to get tested before they trick in private or have safe sex and continue not to ask and not telling or to come to be free. I think it does not feel good when anyone test HIV. The study is just a bit of knowledge to help End AIDs.